Provider Demographics
NPI:1366801763
Name:ALL DOLLED UP UNISEX BEAUTY SALON
Entity type:Organization
Organization Name:ALL DOLLED UP UNISEX BEAUTY SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE COSMETOLOGIS
Authorized Official - Phone:407-394-7982
Mailing Address - Street 1:3228 W. STATE ROAD 426
Mailing Address - Street 2:SUITE 1008
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765
Mailing Address - Country:US
Mailing Address - Phone:407-622-0422
Mailing Address - Fax:
Practice Address - Street 1:3228 W. STATE ROAD 426
Practice Address - Street 2:SUITE 1008
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765
Practice Address - Country:US
Practice Address - Phone:407-622-0422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL1204705174400000X
FLCL0147595174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty